4 Keys to improving patient flow

Patient flow or patient throughput has become a major concern for most hospital CEOs because their organizations are beginning to experience the real human and financial costs of not addressing the issue: dissatisfied patients, compromised quality of care, holding patients in the most costly areas of the hospital, lower reimbursement. The list goes on and on. Bottlenecks and delays must be addressed and minimized.

The Emergency Department has become ground zero for patient flow improvement initiatives. This first point of entry for many patients can be a make or break the patient flow scenario for a hospital and impact both patient and workforce satisfaction.

"This is a challenge that must be tackled by all departments caring for patients, not just the Emergency Department," says Kirk Jensen, MD, Chief Innovation Officer for EmCare and a nationally-recognized authority on patient flow. "Approaching and solving patient flow issues requires senior executive support; a carefully designed, strategic approach; the skill to analyze and interpret data; the ability to design effective interventions; and enthusiastic participation from all areas of the organization that touch a patient."

Dr. Jensen identifies four keys to improving patient flow:

Add value, eliminate waste. The quest for optimum patient flow is a continuous treasure hunt to add value and a continuous bounty hunt to eliminate waste. In today's patient-centric world, value is defined as the ratio of benefits to burdens. The 3 "Ds" of value-added physician input that contribute to enhanced patient flow are Deciding, Documenting and Doctoring. Non-value added factors that inhibit patient flow include: searching, waiting, rework, redundancy, unshared knowledge, making it up as you go and variation in practice among different physicians. "If what you're doing doesn't add value, eliminate it," says Dr. Jensen. "Using tools and techniques such as lean methodologies and value stream analyses can help hospitals identify unproductive, wasteful components in the patient flow pipeline."

Align incentives; get everyone on the same page. Organizational integration creates an operating structure that leads to better communication among clinicians; better communication between clinicians and administrators; more efficient practices; better quality of care and clinical outcomes; improved patient, medical staff and referring physician satisfaction; improved metrics; and financial synergies, all of which lead to an enhanced ROI from improved patient flow. "Technology-supported solutions such as EmCare's Rapid Admission Process and Gap Orders™ (RAP&GO™) use proprietary evidence-based software with predefined protocols to facilitate improved hand-offs between emergency and hospital medicine physicians for those patients admitted from the E.D. This type of solution significantly decreases boarding time in the E.D. and opens up considerable opportunity for new E.D. volume and improvement on CMS quality measures.

Match capacity to demand. "There are opportunities across the entire patient flow continuum. Patient flow and throughput consists of a series of networked bundles of processes," says Dr. Jensen. "The front end of the process involves pulling the patient into the system of care and triggers measures including door to triage, door to doctor and door to bed. Once the decision has been made to admit or discharge the patient, the focus shifts to pulling the patient through to the appropriate setting of care. Analyzing E.D. admitting processes and metrics enable hospitals to identify trends and smooth out staffing to provide the right staff at the right time in the right setting to provide the right treatment."

Teamwork is the key; it's about people, processes and handoffs. Effectively addressing the patient flow challenge isn't solely the responsibility of the E.D. It's an organization-wide issue that requires the best thinking and participation from all areas that touch a patient during his or her hospital experience. Eliminating bottlenecks, stamping out workarounds, minimizing waits and getting the doctor, nurse and patient together as quickly as possible are the building blocks for high quality, cost-effective patient flow. Customized staff education and training provide the platform for consistent, reliable and effective communication, clinical operations and quality care.

Patient flow is a complex, technical challenge. "Fixing" the flow issue doesn't involve simply bolting on solutions. Rather, it requires marrying strategic insights with a great deal of skill and experience. Partnering with experts and engaging your healthcare team(s) rather than simply trying to reinvent somebody else's wheel generally offers the quickest, most effective approach to solving patient flow issues.

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